Post-Prostatectomy Pelvic Floor Recovery: Expectations, Timelines & Exercises

Written By Angelique Montano-Bresolin

Molly Drazin, PT, DPT
Pelvic Health Physiotherapist

Key Takeaways

  • Pelvic floor recovery after prostate surgery takes time and consistency of exercises

  • Most men see improvement in bladder control within weeks to months

  • Working with a pelvic health physiotherapist both before and after surgery can improve recovery outcomes and confidence

What Should You Expect After Prostatectomy?

A prostatectomy is a surgical procedure for the partial or complete removal of the prostate, most often used to treat prostate cancer. Like any surgery, the incisions and procedure will impact the tissues involved which include the pelvic floor muscles and nerves supplying them. As a result, common post-surgery symptoms include:

Everyone's recovery after a prostatectomy is different. Some men experience only mild symptoms that improve quickly, while others may have more significant urinary leakage that takes longer to recover from. The first few weeks after catheter removal are usually the most challenging, with symptoms gradually improving over time. 

Some factors, such as being over the age of 70, can increase the likelihood of experiencing more severe urinary incontinence, and unfortunately age is not something we can change. The good news is that there are factors we can influence. Research has consistently shown that strengthening your pelvic floor muscles before surgery can improve post surgical urinary continence outcomes and support a smoother recovery. Preparing your pelvic floor before your operation (often termed “prehab”) is one of the most effective steps you can take to help optimize your recovery.

Pelvic floor physiotherapy can support you both before and after your prostatectomy. During the prehabilitation phase, we'll assess your pelvic floor function and teach you exercises to help prepare for surgery. After surgery, we'll guide your recovery with a personalized treatment plan designed to improve bladder control, restore function, and help you return to the activities that matter most to you.

How Long Does Pelvic Floor Recovery Take After a Prostatectomy?

Recovery after a prostatectomy is different for everyone, so it's difficult to predict exactly how long healing will take. While every person is unique, most people begin to notice improvements in their symptoms within 3 to 6 months after surgery. This timeline reflects the body's natural healing process, the time needed to build strength, and regular participation in a home exercise program.

Take a look below to break down this timeline further:

0–2 Weeks Post-Surgery

  • Mild swelling, bruising and pain from incision site

  • Management of the urinary catheter

  • Focus on general healing of tissues

After Catheter Removal (typically 1-3 weeks)

  • You will likely notice immediate urinary dribbling and/or leaking

  • Be prepared with pads to help absorb any leakage

2–6 Weeks

  • Begin or resume (if you did prehab) pelvic floor exercises after catheter removal (a pelvic floor physiotherapist can ensure you are doing the exercises correctly if you are unsure)

  • Gradually return to light daily activities (avoid heavy lifting)

  • You may notice early improvements in urinary function and control

6–12 Weeks

  • Progression of pelvic floor exercises to include more functional activities

  • Return to heavier daily activities

  • Improving pelvic floor muscle strength and endurance gains

  • Improving bladder control and reduced urinary leakage

3–6 Months+

  • Continue to make gains in strength, confidence and symptom management

  • Continue to progress exercise intensity and challenge

  • Ongoing physiotherapy may still be beneficial for some

It’s important to remember that recovery is not linear and we often see periods of plateau and setbacks along the way. This is normal and should be expected, and does not mean you should stop your exercises or give up. A pelvic floor physiotherapist can help you understand what may be contributing to these challenges and how to overcome them to meet your goals.

Which Exercises Help Recovery the Most?

Let's revisit the anatomy for a moment. During a prostatectomy, the prostate is removed along with the internal urethral sphincter—a muscle that helps keep urine in the bladder. This sphincter muscle works automatically which is why you’ve never had to think about it before. Without it, this is one of the main reasons urinary leakage is so common after surgery.

The good news is that your pelvic floor muscles are not removed during surgery. These muscles also support bladder control and have both an automatic and manual control, which means with conscious practice and training we can get them to replace the job of the internal sphincter too.

That's why learning to perform pelvic floor exercises correctly is such an important part of your recovery. It's not just about strengthening the muscles—it's about teaching them to activate at the right time, such as before you cough or stand up, to help prevent urine leakage. The exercises below will help you build this skill and support your recovery after surgery.

  • Pelvic floor contractions (Kegels): distinguishing anterior and posterior muscles

  • Endurance holds

  • Quick contractions

  • Coordination with other muscles

  • Isolation (limiting compensatory muscles)

  • Pre-contractions prior to functional activities to prevent leaking

  • Pelvic floor relaxation may be important for some people too

Conclusion

Recovery after a prostatectomy takes time, but for many people, meaningful improvements in bladder control are achievable with consistent pelvic floor training and the right support. Ideally, coming in for pelvic floor physiotherapy at least 4–8 weeks before surgery to begin a personalized prehabilitation program to optimize your post surgical recovery. If you weren't able to do prehab, the best time to start rehabilitation is after your catheter has been removed, at which point you will receive an individualized treatment plan after assessment. Staying consistent with your home exercises can make a significant difference in your recovery and help you return to the activities that matter most.

References

‍Johns Hopkins Medicine. (2022). Radical prostatectomy. In www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/radical-prostatectomy

Scott, K. M., Gosai, E., Bradley, M. H., Walton, S., Hynan, L. S., Lemack, G., & Roehrborn, C. (2019). Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain. International Urology and Nephrology, 52(4), 655–659. https://doi.org/10.1007/s11255-019-02343-7

University Health Network. (2026). My Surgery: Radical Prostatectomy Guide. Www.Uhn.Ca. https://www.uhn.ca/Surgery/Urology_Surgery/Radical_Prostatectomy

Angelique Montano-Bresolin
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